Reversal of Claim.

On 16/02/2018 I called Discovery Health call centre to confirm benefits and where they would be paid from. I spoke to a gentleman as I wanted to confirm benefits from the Screening and Preventative benefits for prostate check and pap smear. I specifically phoned the Gynaecologist and Urologist prior to this to get the codes so I can give this to Discovery when I call as I wanted to be certain.

I gave the consultant the following codes. – Urologist. N40 ICD 10. 0191 and 3628. Gynaecologist. – 0191 and ICD 10 Z01.4. Knowing that 0191 is the consultation code and 3628 for the ultrasound. I specifically asked if these codes would be paid from the screening and preventative benefit or from savings. The consultant confirmed this would be covered from the screening and preventative benefit and not from the savings. I asked him to confirm this in the same call numerous time, which he did.

Based on the confirmation received we visited the Urologist on 19/02/2048 and Gynaecologist on 23/02/2018 for these confirmed procedures. Only to see these claims (0191 and 3628) were then processed and paid from the savings and not the screening and preventative benefit as confirmed but Discovery. Besides the actual pathology which was paid from the screening and prevention benefit.

I called Discovery to query this and spoke to Gill Mdluli. I am not sure of the exact date, but it should be between 24/02/2018 - 27/02/2018. She told me she will listen to the call. She called me back to say she did listen to the call and confirm this is what the consultant confirmed with the multiple times. She sent me an email with inquiry reference number: ********** 624 on 27/02/2018 saying that an inquiry has been opened for reprocessing these claims on 26/02/2018 and that she would keep me informed.

I have subsequently been sending more than 10 emails asking for feedback and for this to be revolved and reversed from my Savings. I have received a call back on the odd occasion but with no actual feedback to this inquiry, only to say it is with QA and they are looking into it.

We are in middle April and I am at my widths ends with this matter. The service is terribly poor as all I get are commitments to call back etc and they are not kept. The claims are still not reversed from my savings. There was one reversal from my Gynaecologist for an ultrasound they should not have charged for, but this is separate to these claims in the inquiry. 2 months for one query is absurd!